Biohackers take aim at big pharma’s stranglehold on insulin
freethink.com
freethink.com
Could someone please point me in the right direction where I can read anything with more substance than a news article quoting an interview?
EDIT: Just to clarify. We're extremely fortunate that we're in Australia. Insulin is affordable/subsidised here, my daughter's CGM (and sensors) are free, and anything else we need is heavily subsidised too. I've no intention of biohacking anything to do with my daughter's Type 1.
I'm asking the above mostly because I'm curious. Admittedly I find it a bit scary that I know so little about the manufacturing of something that is 100% vital to my daughter's survival. I'd like to know more.
Frankly, we should nationalize insulin production and stop people and insurance plans from going broke buying it. Imagine if Medicaid wasn’t paying usurious margins for a commodity that has been around for a century.
Where this is perverted, is that the PBMs have complex compensation schedules wherein they receive a percentage of drug rebates. Their goal is to secure the largest rebate possible. Thus, either negotiate more effectively OR pressure manufacturers to increase list prices and give larger rebates. In practice, the latter happens most often. Insurers don't mind high list prices because they get large rebates and it encourages people to stay insured. Net prices (pharma revenue) on off-patent insulin have declined consistently since mid-2000s [0].
However, insulin is inexcusably expensive due to legacy regulation about equivalence for biologics and sticky patient preferences. Even current net prices are 2-5x too high relative to what a competitive generic market could produce.
[0] https://www.fiercepharma.com/pharma/net-prices-for-insulins-...
What if a manufacturer lowered the price of insulin to $10 a month and gave no rebates at all? Would insurance companies refuse to cover it and pharmacies refuse to carry it?
Your project is too damn important to let this happen. Please find or do whatever you have to do in order to publish what needs to be published. If that means taking a leap of faith, please, for the love of goodness, please do it.
If you or your kid or your friends have Type 1 and are struggling to make your insulin out of pockets please, please, please call the Eli Lily hotline and get the copay card. They've dropped the monthly cost for Humalog to $35.
Don't ration. Work the system. https://www.humalog.com/savings-support
I don't believe this is universally true though. For example, patent-encumbered novel delivery mechanisms for existing (generic) drugs, like Concerta. The drug company has nothing to gain by maintaining the administrative infrastructure for patient-assistance for drugs like that.
Another example are personalised therpaies, such as immunotherapy treatments - which cost so much because (as I understand it, please correct me if I'm wrong) they require individual experts to develop the personalized antibodies and whatnot - unlike with mass-produced medication pills/tablets/capsules that have negligible marginal cost: a company isn't going to give away a $100k therapeutic drug for free because it still is going to cost them $50k+ (numbers just made up btw).
Not to mention that services like foodstamps can be unreliable… I’ve probably spent hours of my life holding up checkout lines because my card didn’t process…
not having money is one thing, but being poor also obliterates your time if you use various services…which in my experience is worse… you’re always tired and agitated. Someone is always messing up your paperwork, because of course civil servants are often underpaid and overworked themselves.
Looking back they were probably just overworked and exhausted, but man.
People blame bureaucracy, and maybe there’s some truth there, but if these people were treated half as well as many tech workers are then maybe we could actually start making progress against the stereotype of miserable experiences.
Nobody who has drive and wants to get shit done lasts very long in that environment. There are occasional pockets of "good" but they don't last because when they accomplish too much people move up and out or they get reigned in by the rest of the system.
Source: members of my household work in government providing social services.
Better known by the people who actually work there as, "Shoving a bunch of people and papers around to show you're changing things, with no plan, strategy, or even background information to support a single thing."
If you think alternating parties solves the problems, you have another think coming your way!
Because for a customer who would pay nothing if their only choice was to get the drug at full price, settling for a reduced price (especially when you also get a tax deduction, and some PR benefit from advertising the discount for the needy) is more profitable than not settling.
You are correct that companies do have patient assistance programs. What you’re leaving out is that this applies to a small subset of people that usually have to be denied federal/state insurance, not have any other kind of insurance, and make less than 4x federal poverty level.
additionally, they rarely provide a lifelong supply. Imagine being a diabetic and novo nordisk, who makes most of the insulin types on the market, only gives you a four month supply.
Oh wait, thats exactly the terms of their patient assistance program.
Just a W-2 or a federal tax return should do - not like those poor people should care about their data or privacy or dignity or anything ~s
Gilead would reimburse any out of pocket costs.
Even still it's just a sick game to bilk insurance companies, and thus us insurance premium payers, out of more money while pretending to be looking out for consumers. The monthly cost on my really great insurance was still over $1k out of pocket, which took a bunch of paper work and over a month to get back. Poor people don't have that luxury.
Oh and now that Gilead's license has run out they have a new very expensive PrEP drug magically appear. Which they tout doesn't have as bad long term downside on your organs. The skeptic in me seems to think the timing is too perfect. if there is a safer drug throw it out asap. maybe they did, I can't know that but I have a strong distaste for Gilead in particular.
For-profit healthcare is one of the biggest moral failings of our country.
These discount programs aren't some big secret people don't know about. I see that argument thrown out in defense of high prices but it simply isn't true. Every doctor prescribing drugs knows about them and tells their patients about them. If people are going without necessary medication because they don't know about a discount program then they are extreme outliers.
These discount programs are simply marketing & lobbying tools used to give politicians cover when they all continue to ignore meaningful healthcare reform.
I kind of figured all of the dead diabetics in the US that I’ve read about over the years was the result of a structural problem with our healthcare system. Apparently this is maybe an issue with suboptimal Google AdSense campaigns that led to fewer diabetics knowing about the font of free insulin?
What a revelation that the manufacturers that control the pricing of this life-saving drug (and apparently all other drugs) are actually blameless in every scenario and that anybody that rations and/or dies does so to themselves due to being dumb.
The comment that I’m responding to strikes me as either alarmingly uninformed about the material conditions that many, many diabetics find themselves in, naïveté based around completely believing some marketing pamphlet, or genuinely making statements in bad faith. I chose to respond in a sarcastic way in my previous comment because the nature of that statement is so incredibly outlandish and broad that it genuinely seems like a comment in bad faith.
“All pharmaceuticals are free if you just go to the website” is genuinely such a dada-esque-ly untrue statements for the majority of Americans that I can only imagine a person making that statement as a joke or a lie.
No, they don’t all provide their drugs for free, but most of them offer directly or fund assistance programs that provide either free or reduced cost drugs.
This is the worst exploitation and gaming.
1% get the freebies. And 99% get to pay a price that’s 10x the sticker cost.
That’s a rip-off and a complete burden to insurance and tax payers.
The premiums for part D in Washington State are about $40 a month [2]
Most Medicaid recipients don't pay out of pocket for insulin.
[1] https://www.medicare.gov/coverage/insulin [2] https://www.insurance.wa.gov/what-does-medicare-prescription... [3] https://www.commonwealthfund.org/publications/issue-briefs/2...
While this is a great thing, it's also necessary that you be prepared to fork over personal data - especially proof of income - and otherwise do whatever is required to prove that you are (un?)worthy enough as with any similar medical financial aid program.
https://www.lillycares.com/assets/pdf/lilly_cares_applicatio...
I believe that regardless of whether someone is at a financial disadvantage, neither business nor government should have the ability force them to surrender both dignity and personal financial information in order to receive aid.
It's hard enough to ask for help without having to lay your life bare to strangers in order to receive it.
There's a lot that's ridiculous about bread being so expensive that recreating the entire supply chain in your backyard is the only economically viable option for obtaining it.
The metaphor pretty clearly was not about critiquing baking as a hobby.
In addition to doing it the way you described (put out flour and water in a bowl and wait for it to bubble and smell nice), you can also buy a $100 microscope, collect wild yeast, clean the bactiera off, and grow mass cultures. Sometimes it pays to work at the last step of the industrial, scientific and agricultural revolutions.
Insulin must make it into the bloodstream intact, typically through injection. It’s also incredibly potent, a unit of insulin dried to crystalline form weighs less than 40 micrograms, so it much be administered in a sterile carrier fluid.
Lastly the penalty for overdosing is generally called insulin shock or diabetic hypoglycemia, and ‘it is rare but possible for diabetic hypoglycemia to result in brain damage or death. Indeed, an estimated 2–4% of deaths of people with type 1 diabetes mellitus have been attributed to hypoglycemia.‘ [1]
That’s with pharmaceutical insulin, not DIY.
Regardless, it was all still done with science: Observation followed by trial and error informed by those observations. Maybe not the scientific method formalized by Francis Bacon, but it's still there in the outlines.
Either way, I don't see a fundamental aspect of the scientific method missing from an observation -> trial -> results loop. I also don't see crop cultivation as unintentional, although I'm not clear what you meant by that. What wasn't intentional? Deciding to experiment with planting seeds would have been a deliberate choice. Probably based on some observation that where wild grains were gathered together and and little things fell off of them, sometimes the same type of plant would grow. Followed by the idea that putting those things in different places might produce the same effect. Etc.
I don't think you get from wild gathering in a nomadic lifestyle to settled agriculture without observing, coming up with ideas about what you observed, testing those ideas, and checking the results. That is. A scientific process.
Toesinte turning into maize would may have simply been a blind generations long domestication process, but not that spark of insight and experimentation that led to stationary agricultural societies.
We could revoke the IP and thus force these companies to compete on price... but that hasn't happened. Thus the only solution that is making any progress is circumventing the IP and developing an open process.
There is IP around the production process (specifically the genetic strain of e-coli). Because the production process is biological, generics produced with a different process are not automatically approved by the FDA and have to undergo an expensive approval process. Thus the goal here is to devolop a process with open IP and get that process approved.
You really need to buy out trade secrets of this particular brand.
This is not really decentralized and is really risky, for obvious reason. https://www.ibj.com/articles/eli-lilly-asking-employees-to-w...
I think you are severely underestimating what it takes to produce a protein drug like insulin. Getting the bug to make it is just the first step. Then next step is purifying it. Which takes SO much water, and salts, and specialized equipment (resins, columns, high-pressure apparatus). A decentralized insulin production scheme is going to be VERY ecologically destructive.
Buying out a patent and properly documenting it should be doable.
Insulin, though is possibly one of the most nightmarishly difficult proteins to make. It's kind of astonishing to me that Insulin was both the first protein sequenced and the first pharmaceutically relevant protein synthesized. Mother necessity, I suppose.
Genentech started making separated-chain insulin in E coli, back in the day, and that is emphatically not how it is done today. You get a whole bunch of crap because you need to keep the two chains denatured, and that results in scrambled disulfide bonds. If you try to do it in protein-folding conditions, one of the chains crashes out into plaques structurally similar to alzheimer's plaques.
You could make it as a single-chain protein, and then cleave out the middle section, except that the protease that you would use to cleave it out has another site internally!! And all of the proteases which leave a "clean end" leave a "clean end" in the wrong direction to yield a good insulin molecule.
Industrially, insulin is made (in yeast, not E coli) by going ahead and cleaving at that extra site, and then performing a reverse proteolysis to install a synthetically generated peptide, restoring the molecule. That's also why most insulin variants (e.g. humalog) have mutations in the tail end, that's the part that is "reinstalled". Note how crazy this is. Proteases are usually used to break proteins apart. Although technically all chemical reactions are indeed reversible, to force the chemical reaction in the other direction, you're fighting entropy, to put humpty dumpty back together again.
Honestly OIP's best shot is probably Michael Weiss' one-chain insulin molecule, which should have gone off-patent this year (https://patents.google.com/patent/US8192957B2/en) (15 years, right? IANAL) but for some reason got extended to 2028!!
However, the big danger with insulin analogs is that you really need to test the F out of them because insulin cross-reacts with the IGF-1 pathway and cause cell hypergrowth = cancer. I would also be very careful with home-made stuff because I would need to be convinced that the forumlation whipped up doesn't change the properties in such a way to to increase IGF-1 activation.
I advised Open Insulin on a ton of stuff in the first few months, but they took literally none of my advice on anything, and last I checked their mailing list a few years ago they were still stuck on some stuff I warned them about (e.g. insulin doesn't stain in coomassie blue -- another thing which makes insulin a pain in the ass).
* How do I know that every vial has the same concentration of insulin each time? That is to say 1 unit from a vial today and 1 unit from another vial is going to have the same dosing.
* How do I know the insulin is purified? If there’s any host cell protein in the vial, that could be immunogenic and cause bad side effects.
* How do I know that the formulation of insulin in the vial won’t degrade on me at whatever storage condition is stated?
I realize that these tests make up only a small fraction of the price, but there’s a lot of value to purchasing medicine from regulated sources. I’m not against upstart competition against big pharma, but I worry that you might literally kill someone if you don’t include these product quality steps in your process.
Where are you getting this from? This goal of this isn't to have every diabetic brewing insulin in their garage so they evade the IP police in a distrubuted fasion. The goal is to create open IP needed for creation, purification and quality control that will allow labs around the world to create insulin in keeping with local regulations.
We have a team in fact that evaluate the FDA requirement and looking at what would be the best way to do it.
Also, Open IP means for us that we will share the modified strains which are optimized for the expression of the insulin, and ideally, we will be able to provide scientific knowledge and resources to help the creation of local manufacturing plant.
If they cribbing off a "process patent" then it's not reverse engineering, though, IIRC, for most drugs companies don't bother getting a process patent because they are very difficult to enforce (to enforce such a patent, you need a warrant to go onto a competitor's premises and inspect their process, and judges are very very unlikely to issue such a warrant because if they set a low bar precedent for such actions, then basically everyone is going to start issuing spurious claims), so everyone would rather just build their moat with trade secrets than process patents. Also, I believe if you crib off of a process patent to do a one-off run or research project it is not illegal, only commercializing it is. One (ostensible) point of patents is to encourage sharing and desiloing knowledge and keep things out of the dark so that we can learn from each other.
The whole point is to open source the batch record.
Wal-mart sells insulin for $24.88 a vial without prescription currently.
It's only the newer 'guchi' insulin brands that are crazy expensive. Stuff from 1996 that is compared to in this article is actually cheaper than it was in 1996 (adjusted for inflation).
It's likely not what your doctor prescribed, it doesn't last as long, it requires you (or your young children) to eat on a very specific schedule, it can't be used with an insulin pen or insulin pump, it's just all around a worse and less effective treatment.
Perhaps it is because there a huge amount of risk involved?
FTA: >In 1996, a vial of Humalog produced by Eli Lilly cost $21. Today, it's priced at $324 despite the cost of production remaining steady.
>Rising costs are nothing new. Insulin prices tripled from 2002 to 2013, and doubled between 2012 and 2016. To put this into perspective, in 1996 a vial of Humalog produced by Eli Lilly cost $21. Today, it's priced at $324 despite the cost of production remaining steady.
If everything is working as intended, it begs the question, what institution intended for patients to die from rationing insulin[0], and why is the USA ok with that institution's intention?
[0]https://www.ontrackdiabetes.com/live-well/diabetes-managemen...
Otherwise, you seem to be repeating the old economics joke:
"The young economist looks down and sees a $20 bill on the street and says, “Hey, look a twenty-dollar bill!”
Without even looking, his older and wiser colleague replies, “Nonsense. If there had been a twenty-dollar lying on the street, someone would have already picked it up by now.”"The world has many very smart people spending many hours working very hard to find these opportunities, so the likelihood of it just sitting there like a $20 bill on the street, and not being picked up, seems quite small.
I do not know the answer myself, so I am interested in finding out. reddicky posted this:
https://www.hopkinsmedicine.org/news/media/releases/why_peop...
which sort of answers it:
>Biotech insulin is now the standard in the U.S., the authors say. Patents on the first synthetic insulin expired in 2014, but these newer forms are harder to copy, so the unpatented versions will go through a lengthy Food and Drug Administration approval process and cost more to make. When these insulins come on the market, they may cost just 20 to 40 percent less than the patented versions, Riggs and Greene write.
So it looks like there is some expensive expertise involved and investment into R&D that needs to be done.
The insulin in question is Lyumjev from Eli Lilly.
In theory there is 'nothing' stopping another company from coming along, even a group of Biohackers may try to do something - I wonder if that's been done... :)
I would imagine that even other companies already in the pharma space would be interested. They don't want to play the race to the bottom game with billions of dollars in upfront costs. If anything, it's probably more profitable to make a new form of insulin that you get to patent. Which is how we end up where we are.
[0] = https://www.cnbc.com/2019/03/25/eli-lilly-discloses-pricing-....
See https://www.fiercehealthcare.com/payer/facing-criticism-pbms....
https://www.macrotrends.net/stocks/charts/CVS/cvs-health/pro...
Cigna purchased Express Scripts in Mar 2018, and has profit margins of 3% to 5% over the last couple years.
https://www.macrotrends.net/stocks/charts/CI/cigna/profit-ma...
If these PBMs are making lots of profits, then they are simply subsidizing losses elsewhere in the MCO. The total costs paid for insurance premium plus out of pocket costs by the end user in the US would not be affected.
PBMs are important but they should not be able to put a gun to these pharma companies heads because they control the formulary.
CVS net margin includes their retail business. You can't compare AWS's margin to Walmart's e-commerce margin.
As a customer, it does not affect me.
In the healthcare business, the flow of money is:
Individual -> MCO (insurance company) -> healthcare providers and drug manufacturers
What does it matter to the individual what portion of an MCO is earning what profit if the net profit margin of the whole MCO is 5% or less? They are obviously not left with a lot of money, their employees are not known to be lavishly compensated.
https://1.bp.blogspot.com/-ZfBANMMU5dQ/XzFtNw93ZCI/AAAAAAAAq...
This sounds like it's responding to a strawman. Proponents of the patent system aren't claiming that zero innovation would happen without patents, just that it would be much less. In other words:
No patent system: only inventions from altruistic inventors
Patent system: inventions from altruistic inventors and profit-focused inventors.
It would depend on the project's margins and/or sunk costs. A project that had very little invested in it or is a breakout success might we able to weather a 50% cut in exclusivity period, but a marginal product might not. Most of the already developed drugs are probably going to be fine, assuming that the financing for them was already secured.
>or would they keep trying?
For the projects at the margins? most certainly. That is not to say all private drug development would, stop. If some sort of unpatented-but-super-cheap-to-perfect-but-still-not-patented drug showed up it might still be developed, but in aggregate I'd expect drug development to drop significantly.
How does the act of buybacks imply that there are no marginal projects?
It's changed a lot recently as doctors have become more aware of the cost of these drugs. But you still have to self advocate for less expensive drugs. Less savvy people often have trouble getting transparency into drug costs. Often even the doctors can't get a straight answer on pricing and insurance coverage.
Additionally, managed care organizations (MCOs, commonly known as insurance companies) do not pay for brand name medications just because a doctor prescribes them. If the MCO is aware of a generic option, then they will only pay for the generic or they will ask the doctor for a "prior authorization" to justify the use of a brand name medicine (such as the generic version not working).
The pediatricians I have visited in recent years even have the MCOs' formulary available for the patient in their systems, so they can see which medicines need a prior authorization and which do not so there is no time wasted on figuring out what the MCO will pay for without prior authorizations.
This is so obnoxiously common across every profession.
People are willing to piss away other people's money on "the best" without even telling them what the options are.
Every time I try to wrap my head around this stuff. How to fix the problems with our current system. I keep coming back to socialized or single payer health care.
Sure the current system works okayish for people like me. Insured and employed. But for my friends and the people I meet on the streets or the grocery store it's a nightmare. There is real suffering and death caused by no access to adequate health care. Even basic preventative stuff like diabetes care and checkups is missing.
https://khn.org/news/you-can-buy-insulin-without-a-prescript...
There's no simply substituting. These are two different brands of a generic statin pill or something. Although it's all insulin, these are very different drugs. The dosages for the same insulin in the same patient can vary, and the calculations or charts for what to take when vary across types of insulins. The handling instructions vary. There's different patient training for a pen vs. a vial and syringe.
https://khn.org/news/you-can-buy-insulin-without-a-prescript...
The different between NPH (regular insulin) (maybe R too, not sure??) sold by walmart and Fast Acting insulins (Novolog, Humalog, Apidra) is massive.
Fast acting insulins start working at about in about 30 minutes and "peak" at like 2 hours, and may slowly have some effects for another 1-2 hours.
NPH on the other hand, starts working at ~2 hour mark and continues to work slowly until peaking at like 6 hours and slowly degrades away, that means its in your system for something like 9 hours - trying to meal plan around multiple doses of that is unsafe at best.
R is slightly better but still remains and slowly peaks closer to 4 hours.
These are obviously GREAT IF and only IF you dont have access to fast acting. I applaud Walmart for giving access to these, as they are way better than nothing.
source: Type 1 diabetic
Slightly exaggerated, but only slightly: Imagine you could only drink water 6 hours before you got thirsty, but if you drank too much you might pass out (at any point 2-6 hours from now) or if you drank too little you're doing major damage to your body.
Really the only way to manage with that kind of insulin is to live a very, very low carb lifestyle. Its doable, but it limits your variety and leaves you prone to other potential issues.
Whereas, if you use pens (or from a vial) with direct injection, you also take a long acting insulin (levemir, Lantus, etc) once or twice a day (they are supposed to last 24ish hours but often people find splitting their total daily dose up into morning and night has better results). And these insulins cost even more than the fast-acting stuff.
See https://www.fiercehealthcare.com/payer/facing-criticism-pbms...
That is exactly what is happening, and it's legal. It's very easy to hide profits and move them around.
However, insurance margins remain unaffected as the money did, in some sense, go out the door and is no longer in control by the insurer directly. It's not fraud. It's just anti-competivie self-dealing. So, no, it's not profits per se, but rather increased valuation via clever financial engineering.
A quick search shows me that on page 73 of Cigna’s 10-K, it clearly does not have its Express Scripts division accounted for in the “Investment Assets” section, based on how low those numbers are.
It just does not pass the smell test to me. The simpler answer, based on all the numbers, is that managed care organizations are squeezing other entities in the healthcare chain, but due to competitive pressure and upper profit margin limits due to ACA, they are not raking in big bucks.
https://www.hopkinsmedicine.org/news/media/releases/why_peop...
Yes, there are different insulins and Novolin is an intermediate-acting insulin like you describe and available at those prices.
Humalog's patents have expired, as I understand it, but cartel behavior has kept the price high in the US.
Edit: Perhaps high speed internet vs dial-up would be a better analogy to spare us the comments about how bikes are actually better than cars...
And that's with the $700/vial insulin... the $25/vial stuff is stone age technology by comparison; you have to take it twice a day, and then eat at two specific times afterwards, or you'll go hypoglycemic (unconscious or maybe dead hypoglycemic, not just the feeling-a-bit-tired kind that people who don't use insulin are familiar with).
The situation right now is that the best and most expensive T1D technology, even the various "artificial pancreas" solutions, still gives you nothing like the experience of a normal pancreas. It would be really nice if the Walmart insulin were a viable long term solution for the cost problem, but unfortunately the negative health effects of older insulin tech are considerable :(
T1 is really complex even with a low carb diet, if you don't only eat vegetables, but meatier food.
Unfortunately (doctor's orders) I also have to cut back on the cholesterol, which seems to be very high in all my favorite low-carb foods :( It's a constant experiment; it may turn out to make more sense to eat more fat but take statins, but I need to wait a bit longer and see how my lipids look with the current diet.
(BTW I'm actually doing fine -- pretty decent control/A1C -- but I had to rant in response to the Walmart insulin suggestion above!)
- waking up, liver produces glucagon
- stress at work, hormones going wild… including glucagon
- weather changes, when it is cooler you need more insulin
- you get sick. 2-3x insulin for me
- liver just having a normal glucagon production, that needs insulin without you ever eating anything
Nice that you have your A1c in control. Mine is 5.8% without too many hypos after 26 years of having T1. The tech I need for this costs a fortune without insurance, but at least I can finally live a normal life without nasty surprises every day.
Generic Novolog is also ~$55 at Walgreens (more at other places).
The regular stuff is not really stone-age by comparison. They are both old tech.
Bear in mind: when you mis-dose insulin, your blood turns into acid.
No endocrinologist would ever recommend treatment with older insulins over the new stuff. The only way it happens is because of cost.
Medical research guided by the idea of preventing disease rather than creating expensive life-long treatments, and prioritizing the diseases that cause the most amount of suffering rather than present the best opportunity for profit. And not just medicine, but just about any industry could benefit.
So, if you're looking to cure something you're going to struggle to find funding.
Don't worry though, the economy will survive.
And their family than learns who actually funds cancer research: they do.
It's funny because your statement was supposed to support the idea pharma only do good things but instead it exactly shows the failure mode of capitalism in medicine: when you get sick, its very often that you do not have the time or capacity to be a informed consumer and the entire premise of capitalism breaks down.
Sometimes the pendulum swings too far towards cynicism.
Nobody tell the multibillion dollar biotech industry…
And in case it needs to be pointed out, no, cures are massively profitable. If someone has a cure for a presently untreatable disease you will get money, you will make money, everyone will make more money and everyone will be better off.
Not the people who are currently making bank off of palliative care for that ailment. This absolutely creates perverse incentives that, while not ubiquitous, are hardly uncommon.
Meanwhile, a drug like viagra can be consumed several times a week for decades.
I don't think its pharma execs are sitting their blocking cures, but it is true that they will looks at risk/reward when deciding. If most drugs only have a very small chance of being approved (lets say 2%) and costs billions of dollars to move through the process - of course those that are needed over and over are going to be funded through research more.
I'm going to need see some numbers on this statement. Because from where I'm sitting, the potential market is every human on planet earth, which is a pretty large amount of sales.
Production costs of mRNA vaccines, as well, is quite low, with much of the cost spent so far spent on scaling.
(Not that I don't think what you are doing is awesome, because I do.)
For everyone interested, clickable link https://openinsulin.org/
Very noble cause, I appreciate it.
Even then, modern insulin is apparently quite a bit better than the "classic" stuff.
it's basically how can we come up with a roadmap to making this decentralized insulin without violating any existing patents
Most importantly, it's a while set of single thing patents which means you need a thick, expensive cross licensing agreement most of the time. Even finding out which patents you need is hard, and then the patents are written in a way that nakes them hard to use too, including incomplete in crucial details.
It's a mockery of the original intent of the patent system.
Similar to a pulse oximeter that measures oxygen saturation non-invasively, is there some research on finding similarly the level of glucose in the blood, etc?
Verily (part of Google/Alphabet) had a joint project with Novartis to build contact lens that sensed glucose in tears, but it didn't pan out.
An analytical chemist has assembled a compendium of approaches that haven't panned out here: http://www.mendosa.com/noninvasive_glucose.pdf
I don't think it's reasonable to expect everyone who takes or buys it, to be able to determine if what they need to inject into their body to survive is safe and functional. So yeah, I do think there should be laws and limits on what qualifies, and who's allowed to make it.
Do I think a large corporation is the only thing able to do that? No, but I suspect that it'd be hard to prove you can make the minimum guarantees that it's safe from the first dose to the last. And that you have resources to attempt to compensate anyone you hurt if you do break those guarantees.
If I could just you know, ask a friend of mine to fly to India and bring a monthly supply of cheap India made generic of Humalog, that would be great, right?
and if insurance company kicks in a few bucks for me, that would drive down the cost of care for insurance company as well
More germane to the article, it will be interesting to see what happens over the next 10 years as bio-tech becomes more accessible to hacker types and hobbyists.
Honest question, how do pharma executives walk the streets? If I was engaged in activities that vile I'd be terrified of being murdered by a vigilante.
That country suffers from no central negotiating body to drive down the price, and a manufacturer/insurer virtual cartel. In other countries, government either negotiated a good price, built or subsidized a quality factory.
The remaining people who have problems are in parts of global south for various reasons, some of which involve exploitation and others bad government or warfare, leading to lack of resources and experts.
https://medicalxpress.com/news/2020-01-diabetics-black-canad...
To put it into context, In the UK the NHS buy Insulin at <$35
you can see the prices here: https://bnf.nice.org.uk/medicinal-forms/insulin.html They come from the same companies and are produced to the same standard. How can a bureaucratic "socialist" care system get better price, and a much better availability than a "free market" system. (thats rhetorical, I know why)
Given the number of non and under insured, I just don't understand why its not swinging elections.
The reason it's not a big issue in elections is because lots of people don't vote.
the problem? patents https://www.hopkinsmedicine.org/news/media/releases/why_peop...
Most of the 'socialist' countries don't pay for R&D on drugs; US consumers do. They pay a marginal price based on production cost, but almost none of the fixed price investments in efficacy, safety studies etc.
The US system in no way resembles a functioning market. It's a byzantine spider web of regulatory capture, patent abuse, bad incentives and inertia.
Schedule: NSW: 4, QLD: 4, VIC: 4, SA : 4, WA : 4, TAS: 4, ACT: 4, NT : 4 "
25 vials of 300 units Humalog costs my patients between 4 and 30 Australian dollars.
I can make a 5 minute phone call and get them larger amounts of insulin for the same price, if they are on bigger than usual doses.
https://en.m.wikipedia.org/wiki/Biohacking
I don't know if body hacking can help with Type I diabetes but diet and lifestyle can certainly help with other forms of diabetes.
Only the USA imposes private health cost burdens on the diabetics (from my quick scan of national health info on the web)
The word for this is oligopoly.
It's disgusting that people in america die for lack of an essential drug.
But in America you are supposed to take "personal responsibility" for your own health and biohack your way ouf of type 1 diabetes?! Srsly?
This s a political, not a scientific problem. Call your congresscritter.
unfortunately not likely to do anything as long as the big pharma lobby remains as powerful as it is
Votes are too diluted, and there is no accountability for campaign promises.
Le référendum, c'est Place de la Bastille!
They instead resort to the language of the unheard.
Look for ways to make the patents unenforceable. If diabetics had the ability to make their own safe insulin at home that would be best. Then all they would need is an internet connection and some basic components. The closer we get to that ideal the more empowered they are.
This would actually solve a lot of price gouging for drugs.
However that's only a stop gap measure. What's happening with gating access to insulin is happening to a thousand other products in a thousand other industries right now. Start looking at alternative governance structures. Lord knows everyones got a blog and a half-assed plan to run things better at this point (since the bar is so low).
Just don't poke the bear. As cathartic as hanging 'congresscritters' would be it wont actually solve the problem.
Basically act like you don't expect anyone else to fix this problem for you because nobody is going to; especially if you voted for them.
The thing we can't talk about without risking cancellation is that nearly all Type 2 Diabetes is preventable. In other words, the choices of the many have a significant negative impact on those (i.e., Type 1'ers) who don't really have a choice.
I’ll never know and I’m stuck with it.
Diet. Exercise. Etc. All known to change T2D.
Insulin is made in massive facilities in large batch runs. Making 5X to 10X is basically cost of materials, which haven't really increased enough to justify the price increase.
This is (mostly likely) a rent-seeking situation where a few providers who are allowed in the market are milking it for all the profit they can.
That is also known as demand. They do because they can.
1) Healthcare is a limited resource, like anything else.
2) Prevention, which few if any "leaders" highlight, is a viable alternative to healthcare price increases.
Are there there some nefarious undercurrents? Yes, of course. But to blame all our ills - and remove diet, lifestyle, etc. - on ever increasing demand only makes the current system stronger. People who believe they have no control aren't part of the solution.
Our situation has nothing to do with demand and everything to do with corporate greed. Many western European countries empower their governments to set upper bounds on the costs of medication to reduce the ability of pharma-bros to make disgusting amounts of personal wealth off the suffering of others.
Exactly. The preventable T2D is driving up demand (read: prices) for both T1D and T2D.
I don't know about Canada. I do know about supply and demand. We all do. In the context of healthcare it makes no sense that ppl abuse their health and then expect prices to fall.
What you fail to consider it that the company that controls the particular type of Insulin that Type I diabetics require is charging 80% less in Canada than in the USA with everything else equal.
Do you get it?
Do you get it?
Our real issue here is that there is absolutely no incentives to control costs.
You’d think our ins companies would do it, but I’m practice, they end up negotiating sweet deals with the drug manufacturers. say med X @ $1000/mo msrp, but the ins companies negotiate it down to $400/mo. The drug company makes out like a bandit, and the ins people get kick backs for buying from the drug co, and passes on the costs to the insurance buyers.
I believe they offer R (short acting / 2-5h), N (medium), and L (long acting / 24h). The problem with the older insulins isn't so much that they're faster, it's that they're less "specific" (from my experience). A newer short acting insulin (Apidpra, etc) has a spike in the 15-30 minute range and the spike is steep and the tail (while up to 5 hours) is low. Whereas R peaks in the 30m-1h range and the peak is low and the tail is much higher. As such, you need to plan ahead much better for your eating. It's frustrating, but not horrible. The N and L have similar problems (L is the reverse, where you want a tail equal to the spike, but it isn't).
The newer insulins a just much more convenient and require a lot less planning of what you eat and when... and not as close an eye on your blood.
I wonder how different the production costs are though, my understanding is the costs to consumer are greater than 10x
Source: a T1 diabetic, used all possible insulins in my life. Very happy in Europe.
However, actually _saying_ that tends to get people up in arms, harassing you about how it how it shouldn't be necessary for people to use the older insulins, and how the newer insulins shouldn't cost what they do. Even though everyone actually agrees with them and they're arguing against a point that nobody it actually trying to make. It is... frustrating trying to get people to understand that you agree with them, but you're talking about something different.
I had this exact discussion with one such person yesterday, and I was trying to explain that they are sabotaging their own goals by misrepresenting the issues. And that I WANT them to succeed in changing things, but they're making it harder to do so.
Edit: You're already being downvoted for stating something that is obviously and undeniably true, because people are not bothering to understand what you're saying. I'm sorry for that.
In a way it is killing people, blood sugar control is much easier with a mix of the newer insulins, and patience compliance is much higher. This directly translates into better quality of life and lower disease burden from diabetes complications.
No one can argue that pharmcos shouldn't be paid for R & D that increases quality of life, in civilized countries the taxpayer should and will pay for your medication if it's an improvement over what's already at market.
But here people seem to be arguing that if you can't afford anything else there's still Walmart short-acting Humalog, and you get to bear all the risk, and that's just fine.
Like I actually use an open source pancreas to control my glucose levels so now I can sleep every night without having to worry about dying. This is in Europe where the insurance covers everything and prices are cheaper than in US.
Using the Walmart insulin makes everything much much more complex, and even for the smartest of us, even with the best possible insulins, managing T1 is a HUGE pain and can kill you quite fast.
I hope I misread your comment...
> The high price of tier 1 insulins is killing people
Is (more or less) a lie. While
> The high price of tier 1 insulins is making people's lives considerably worse and their diabetes harder to manage.
Is (more or less) true.
When you try to push for change and use, as part of your argument, a lie, you sabotage yourself. People can point at what you're saying and, ignoring the validity of what you're trying to achieve, say "you're lying". That's bad.
The truth is that there are good reasons why tier 1 insulins should not cost as much as they do, not by a long shot. And destroying your own progress towards changing things is counter productive. Just don't do it.
One in four patients in the US have rationed insulin because of the cost: https://news.yale.edu/2018/12/03/one-four-patients-say-theyv...
It is simply untrue to say the high cost only forces people to use the cheaper Walmart generic. That isn't what happens. They ration it, and sometimes they die.
Finally, it doesn't make sense to say that the high price is making diabetes harder to manage, but isn't killing people. That's like saying speeding doesn't kill, it just makes the car harder to manage.
> One in four patients say they’ve skimped on insulin because of high cost
> say they've
^ is the key component. I expect the vast majority of those people had a choice, and they chose not to take it. A poor choice, and a choice they shouldn't have to make, but a choice nonetheless.
The point is, if you're going to fight for positive change, use an argument that can't be trivially dismissed because it isn't true. Fight effectively.
I would argue these two statements are equivalent:
- My patient was killed by the high price of insulin.
- If the price of insulin had been lower, my patient would still be alive.
I suspect that you accept the second statement, but not the first. What's the difference?
1. If the fatty and sugary foods were too expensive for them to buy, they would not have died from those things.
2. They did not die because fatty/sugary foods weren't expensive. They died because they chose to eat fatty/sugary foods. [1]
Just because X (good insulin being cheaper) would have helped prevent Y (deaths) doesn't mean that <not X> caused Y.
[1] I'm ignoring the fact that truly healthy foods tend to outside the price range of the poorer segment. The analogy only really goes so far here.
- People drive cars.
- Cars are car jacked.
- If people did not drive cars, carjackings could not happen.
- People driving cars is a requirement for carjackings.
- People driving cars is not a cause of carjackings.
I understand that it is possible and truthful to argue that people driving cars is a cause of carjackings; it's just not my view of the meaning of those words.
When people learn that the "old insulin" and "new insulin" are completely different products and that "old insulin" is still available at a low cost, the narrative and goodwill is shattered.
People hate being lied to and they hate being manipulated.
If you want to have a discussion that we should make the "new insulin" available for at low cost of for free, that is great! We can talk about the cost to manufacture and to develop drugs.
There are many smart people here and around the world, when we put our minds to a problem, we can find a solutions.
But by not acknowledging and downplaying the time and effort that companies and people have put into the "new insulin", then you are cheapening the work they have done and are signaling to everyone that you would do the same to their time and effort as well.
It's well known that you need to keep all sorts of things under control with type 1 to avoid long-term health complications. Blood sugar is the most obvious.
I watched my father manage his for decades, starting in the 1980s. The technology improvements were interesting - his first insulin pump (about the size of a VHS tape), the custom software to data-dump his glucose meter, "supply-hacking" to keep the infusion sets affordable...
He still had management challenges despite being a dedicated, disciplined, marathon-running Mormon on the leading-edge of treatment. He was fortunate enough to be involved in the DCCT/EDIC trials at the University of Washington, and took the early lessons about future complications very seriously.
You make Diabetes harder to manage by removing modern improvements to the standard of care, and you are certainly going to see increases in deaths and severe negative outcomes.
I pay zero attention to people and news sources that repeat that behavior more than once. Lead with the truth.
I found some references for "old" versions that claim price increase from $17 in 1997 to $138 today, another from $21 to $255.
Going by inflation only those would be around $30-40.
I don't know how much a typical diabetic needs per month (I imagine it varies) but I could see that being a problem for a lot of people if that is, say a monthly supply.
About $25, that last I checked. The ones you're talking about, I believe, are the "newer" ones (which are not very new). The prices of those have shot up over the years (in the US) for no good reason. It's shameful.
For example, Basaglar is a "generic" of Lantus, but it's still expensive.
Here’s How to Save on Basaglar, the Expensive Lantus “Generic” https://www.goodrx.com/blog/basaglar-expensive-lantus-generi...
> Basaglar contains the same kind of insulin as Lantus (insulin glargine), and while it is cheaper—Basaglar costs about 15% less than Lantus—it is still expensive, with a cash price of around $450 for a 30-day supply.
Unlike normal generics, the bio-similars need to go through their own clinical trials and prove they work the same as the original. They can't just "use the same ingredients" and release it. Mind you, that doesn't explain the extreme price markup, but it does explain why these "generics" don't follow the same "85% cost reduction" of normal generics. They still have, effectively, a costly R&D phase.
At least, that's my understanding.
By the way that same site had an interesting article breaking down costs normalized by insulin unit
https://www.goodrx.com/blog/how-much-does-insulin-cost-compa...
By that table and some assumptions about approx 40 IU/day it looks like the cheapest you could get away with at full retail would be about $120/mo, assuming optimal usage etc. The most expensive version would be at least 5x that.
There are plenty of cases of people literally dying because of difficulty managing insulin due to cost. It’s nice to say other low cost forms are available while handwaving away actual deaths as well as accumulative long term damage from difficult insulin management.
https://khn.org/news/insulins-high-cost-leads-to-deadly-rati...
Many of the “newer” forms are 20+ years old, and are also extremely low cost to produce.
Admittedly, they're not cheap w/o insurance, which sucks. But if you can get one, so do. You won't be disappointed.
We should ask what are the outcomes that these systems produce, not how new the drugs are.
A cutting-edge healthcare system plagued by inequality and extreme costs can produce worse results than a more efficient healthcare system which is not as high-tech.
But yes, I agree. Sometimes the juice isn’t worth the squeeze.
Just repeating the question, when I gave you the answer, isn't very productive.
It’s a for-profit system where literally every cog from drug company to pharmacist has an incentive to separate you from your money.
When Europeans can pick from 5 different spring loaded epinephrine injectors and Americans can only legally buy one from a specific manufacturer, of course Americans pay 5x as much.
In plenty of places around the world you can buy all humulin you want without a doctor or the FDA for $30 vial.
If the state was the single largest negotiator for purchasing hamburgers and representing tens of millions of people odds are you would have more competitive hamburger supply bids.
"African American adults are 60 percent more likely than non-Hispanic white adults to be diagnosed with diabetes by a physician."
Given that the middle class is very white and employed with insurance coverage, it virtually doesn't affect white people. Our politics takes black people's votes for granted and don't do anything for them.
Not every problem has it’s root in division.
IMO it's more helpful to look at this through an economic lenses than a race one. T2 diabetes is very much a poor person's disease.
It's worse than that. If they sufficiently pandered to them to the point of actually solving their problems then they wouldn't be able to take those votes for granted, so they'll never solve their problems.
And while various poll access restriction measures are an injustice one could almost think is intentionally targeted at black people, I imagine those obstacles aside they'd be as free and capable of conscientiously assigning their votes as anyone else.
I say this as a leftist: the Democratic Party is the party of the health industrial complex.
https://www.jacobinmag.com/2021/01/joe-biden-public-option-h...
I await the explanation of your model revealing the drivers of healthcare costs and connecting them to predominately Dem responsibility with baited breath, nigh weeping for hope of policy-capable leftists in the meanwhile.
> Mandatory insurance
You know that's how socialized insurance works at one level or another, right?
> COBRA payouts
Is this a mantra or a point?
> Did you know Gretchen Whitmer’s dad was the CEO of BlueCross?
This is definitely not a point.
> the party of the health industrial complex.
As long as we consider approach healthcare primarily as an industry, yeah, there's going to be industrial interests tangled up with it. Should we do it some other way? Maybe. In which party do you think that conversation is even possible?
The Democrats are the party who put massive amounts of effort into derailing the only viable candidate to argue for public healthcare.
Maybe you don’t care about keeping predatory insurance companies afloat with COBRA payouts, or forcing healthy people to pay tens of thousands of dollars to insurance companies, but plenty of people do.
Sigh.
Look. I appreciate passion for the topic. I absolutely care about this too. I probably spend waaaay more time than a layperson should reading about healthcare problems and policy. Like a lot of other people here on an engineering forum like this, I know the power of approaching things as their own kind of system.
And it kinda looks like you don't yet. That's something I've no doubt you could fix, but you'd have to want it. Maybe even enough to google the term "socialized insurance." Or understand that when healthy people pay into risk pools... that's what insurance is.
> The Democrats are the party who put massive amounts of effort into derailing the only viable candidate to argue for public healthcare.
Presumably you're talking about Sanders. I encourage you to talk to his office while he's not running about other people who are supportive and enthusiastic about public healthcare efforts. There are plenty. Arguably not enough: if they'd had few more Senators to get past Joe Lieberman in 2010, Medicare-for-all-who choose would have been a reality then. As it was the ACA was a mixed but significant policy victory.
They do have regulatory capture, mostly given to them by the Democratic Party.
I can't tell whether you're saying "Health insurance in the US is a commercial industry right now" or "there's no such thing as health insurance that is not commercial."
The latter statement is not true. Medicare for all would be socialized insurance, as would any single payer plan. There are other kinds of socialized insurance you can find in other countries.
The former statement is mostly true with notable exceptions, so we'll assume that's what you mean. You may not be aware there is socialized insurance in the US, though: Medicare and other state programs (and again, the vast majority of Democratic officeholders supported expanding access to that to everyone in 2010 via what was called the "public option" at the time, unfortunately they needed every last D Senator and Lieberman held out). There are also some non-profit private insurers.
> these companies are getting paid tens of millions of dollars. They are INCs.
The money flowing through these companies is not the problem. Getting paid to provide valuable services is not a problem. Even if you had a magic wand that you could wave that made Bernie king and M4A a reality, you would still need to employ people to source revenue for the general insurance fund, provide good financial stewardship over it, manage relationships with competent providers, provide service to people like you and I, etc etc. You'd have to pay all those people. Like Medicare already has to (and hires private parties to help).
It's likely that entirely socializing insurance would cut down on overhead (and certainly on any profit taking), but the thing is... that's already been limited. By who? Well... these Democrats you're suggesting are somehow primarily responsible for nurturing insurers. Where did this happen? The Affordable Care Act required insurance companies to reveal how they spend consumer premiums, and spend 80% of those premiums on care and efforts to improve quality of care. What companies can take in operating expenses and profits is limited by law to 20%.
Did you know that? If you didn't, why are you so confidently holding forth on this topic? If you did, why are you insisting on repeating the line that Democrats don't care and in fact are responsible for increasing expenses and capture of revenue?
> They do have regulatory capture
They have representation and influence in a democratic system. Arguably too much? Yeah. What's your plan for that?
> mostly given to them by the Democratic Party.
Again, you're welcome to lay out your model of how the democrats are responsible. If it's really limited to "other people in the party thought they'd make a better candidate/President than Bernie", though, you might want to see if you can come up with something stronger. And while you're at it, maybe start to admit at least to yourself that maybe you have some more to learn about this topic.
Simple, prior to the ACA I was able to cover my health expenses out of pocket. I’m healthy and literally went to the doctor 3 times in a decade. After being forced by the ACA to buy unneeded and unwanted health insurance, I ended up paying >10k /year for literally nothing.
I’ve since paid so much in health insurance that I could have covered my own cancer treatments, out of pocket. I have received nothing for that $100,000+ dollars.
Add to that the “marketplace” with limited time windows, limited competition, the inability to get insurance from another location…
These were all Democrat initiatives that I lived through.
Then, twice the Democratic Party fought tooth and nail to kill M4A. Biden literally said he would never implement it. I’m no fan of the GOP, but when it comes to healthcare costs, no one is worse than the Dems.
Insurance is not something you have because you are ill, it's something you have as a hedge against the probability that you will be ill. Whether you're healthy now has limited bearing on that.
And if you want to be able to have it when you are ill, you need to be willing to contribute to premiums even when you're not. Whether that contribution comes in the form of an explicit premium paid into a risk pool administered by private insurers or in the form of a percentage of your tax dollars paid to a socialized insurance plan (like M4A), that's how insurance works.
From a political standpoint, the individual mandate might have gone down more smoothly if people had been given a choice to opt out of it, in return for agreeing that they could be denied for pre-existing conditions. Democrats at the time made the calculation from a policy/values that too many people wouldn't understand what they were doing and end up shooting themselves in the foot. I used to think that was wrong.
> I ended up paying >10k /year for literally nothing.
> I could have covered my own cancer treatments, out of pocket. I have received nothing for that $100,000+ dollars.
Your numbers don't add up.
Out of pocket costs for a course of cancer treatment usually run well over $100k (and those stats might be for people who do have insurance).
There haven't been many years that the individual mandate was in effect. It went into effect in 2014. Tax for not buying insurance was lowered to zero by 2019. Your yearly premiums would have needed to be not ">$10k" but around $20k for you to have spent $100k in premiums.
And if you didn't want the insurance, it was always legal to simply pay that tax on not having it. How much? Well, for the median income household, that'd be about $700. Much less than You would need to be pulling something north of $500k a year in order for your tax to be $10k. Please, tell us where you worked, and why they were paying you that much while... not offering you insurance?
Or if you were making $500k a year as a business owner / contractor... why you didn't have any accountant or other financial professional giving you better advice? $10k a year in individual premiums is cadillac plan territory, even in expensive metro areas. Generally not what people who are healthy and go to the doctor three times in a decade buy. High-deductible plans with premiums below $300/mo are available to individuals in Los Angeles today. Your individual max required premium shouldn't be more than $3500 a year in 2021 (and in 2014, you could probably get away below $2400/year). Hell, you could cover a family of four in Los Angeles on less than $500/mo in premiums with ACA assistance, for a total cost topping out below $6000/year, so we know that's not what you're talking about (on top of the fact that you spoke in terms of your own health rather than mentioning any family).
Maybe there's some reasonable explanation for why all your numbers are so far outside of credibility here?
> the Democratic Party fought ... M4A
Please. M4A wouldn't even exist as a relevant concept in American political discourse without the Democratic Party. The only reason you know the label at all is because it was advocated in primary contests and by Democrats in congress. Yes, Democrats plural. For an example, read one piece of introduced legislation:
https://www.congress.gov/bill/116th-congress/senate-bill/112...
Notice the list of D Senators as co-sponsors. Notice that it is not short (nearly a third of the caucus at the time). It is profoundly wrong to characterize the Democratic Party as the primary obstacle to something like M4A when it is the only reason why M4A is a potential reality in the US. And saying "I'm no fan of the GOP" doesn't ameliorate that mistake: you can guarantee that the list of Senators sponsoring anything remotely like that bill in the GOP would have a length of 0 (and of course, given when the bill was introduced, only someone who was also ignorant of the composition of the senate at the time could think the primary reason it didn't go anywhere was D efforts).
Also, maybe check your misconceptions about Biden:
https://www.vox.com/21540041/election-2020-joe-biden-health-...
That's him trying to find a way to make medicare for everyone who wants it.
When I was a single contractor: $900 /month
After I married a healthy partner: $2100 /month for the both of us.
After transitioning to full time employment: $2300 /month
These numbers align with my friends. In no way was paying $300 /month an option.
Health insurance is not health care. I don’t want it. I want public healthcare, barring that I want affordable healthcare. Pre-ACA was much more affordable.
I really wish neo-liberals could just admit when their policies fail. This one is not on the GOP. It’s 100% the result of DNC policy and actions.
I assume you want people to vote Democrat. To be effective there, step one would be to listen to people who have legitimate grievances and when your party is at fault, own it. Do not go on a tirade about how paying for insurance is actually a good thing. It’s not, it’s a failure of our social safety net.
I have no misconceptions about Biden. He was part of the admin that screwed me with the ACA, I watched every debate and heard him repeatedly state that he was going to continue to enrich the insurance industry on my back. Which is exactly what he’s done since taking office.
Edit: source
https://www.cnbc.com/2019/05/20/cramer-bidens-2020-bid-is-se...
https://www.healthsystemtracker.org/chart-collection/u-s-spe...
Spending and costs are distinct, of course, but they're related, and you'll see spending track costs directly unless there's a factor that increases/decreases demand for services
What do we see? An acceleration bump in 2014/2015, and then it settles back into data whose variation is much like pre-ACA dynamics. 2014 would have been when the exchanges and wide reach of access went into effect. The spending acceleration bump was almost certainly people who didn't have access before using medical services.
The idea that the ACA drove some kind of unprecedented increase in costs doesn't track:
https://www.thebalance.com/causes-of-rising-healthcare-costs...
And lots of stocks rose when Biden was nominated (and elected). Sensible leadership prospects have their own positive effect on enterprise.
Yes, because he’s a corrupt corporate puppet.
We need to pick something. If we're going the free enterprise way we need competition, price transparency, quality and outcome transparency, more open markets, and much lower taxes. If we're going the state-run or state-insured way then we need to whole-ass it and vertically integrate and drop the state-backed private insurance hybrid nightmare.
The US does this pessimum thing all over the place. We are taxed almost like a more "socialist" country (unless you are rich enough to offshore and play tax loophole games) but do not get the benefits of one. Either cut my taxes down to Costa Rica levels or give me benefits at least as good as Canada please.
But as it is, insulin is high demand and increasing. Prices simply don't fall when demand increases.
There are no free market health systems in leading economic nations (unless maybe you take a very small niche corner of the systems)
That also does not exist in the US and hasn't in more than half a century. The US could hardly be any further away from a free market in healthcare. It's hyper regulated, and hyper dominated by government programs (Medicare, Medicaid, and dozens of other programs and agencies).
The US healthcare system is controlled top to bottom by rigid, strict government regulations and oversight. It's the way it is precisely because there is no free market at all. The corporatist interests like it just the way it is, and work with the politicians to constantly maintain that highly regulated environment: it's regulated in their favor, exclusionary of nearly all potential competition. And it's insanely expensive to try to start anything in healthcare, which favors the incumbent further.
Try starting a hospital or opening a clinic. Try becoming a doctor. Try getting a drug to market. Try getting a medtech device to market. Hyper regulation every direction you look.
Free market? Ha.
We don’t really know what a true free market would do with modern healthcare because as you say there is no such thing. Personally I think it could work for middle class and above but would leave a big coverage cliff down below because it’s not profitable to insure or treat the really poor.
The question is whether real transparency with price competition and efficiency gains would make it cheaper to then add a safely net for the poor.
https://www.google.com/search?q=lieberman+public+option&oq=l...
The issue, though, is not that it's half-assed and fucked up. It's working by design, to use legislative schemes to funnel money to incumbents and friends/donors, while still supporting the "free market" ideology, when really it's just regulatory capture.
The system is designed for graft, and it's working as intended. Those with the power to "fix" it won't, because to them it's not broken at all.
The US has the same problem in telecommunications, war/defense, and medicine. The largest vendors become integrated with the budget- and policy-makers, and the whole system exists to extract maximum value from the consumer class.
Sorry, but regular people don't make "campaign contributions" of any noticable size, so all we get back is a form letter acknowledgement based on whatever box you checked for subject.
Big Pharma, Big X and Big Y, on the other hand, "donate" enough "campaign contributions" that the campaigner can all but ensure (re) election based on recent name recognition to get the nomination, then counting on "their" voters being unable to vote for the opposite party even with the discovery of a live boy or a dead girl.
https://duckduckgo.com/?q=live+boy+or+dead+girl&t=fpas&ia=we...
https://en.m.wikipedia.org/wiki/Citizens_United_v._FEC
Walk softly and carry a big purse.
[0] https://www.marketwatch.com/story/trump-and-democratic-polit...
[1] https://www.rollcall.com/2019/06/06/what-is-mcconnelling-how...
[2] https://www.theatlantic.com/politics/archive/2015/09/10-ways...
[3] https://www.latimes.com/nation/la-na-politics-superpacs-impa...
This kind of influence is completely untraceable through all the normal disclosure mechanisms since no money actually gets spent. And worse still, it offers enormous leverage— once you have that war chest, you can use it to issue hundreds of threats and only occasionally have to actually follow through.
It's just a completely different ballgame compared to a "normal" campaign finance option that directly spends donations.
What always amazes me is how much this is tolerated in the “Land of the free”. At what point do Americans stand up for democratic principles?
This pathetic “we can’t do anything” attitude will be how democracy dies.
If my electoral district was gerrymandered or corporate donations through PACs we’re allowed in Canada I would be planning protests instead of typing this. Our system is far from perfect, but I have a hard time imagining a scenario in which the public here would passively accept many of the things we can see to the South.
Why is there so much apathy towards these issues?
Shouldn’t the fairness of the democratic system in the US be the #1 issue for both Democrats and Republicans?
Americans vilify their politicians and then expect that somehow really “good” people will get into that profession. I don’t get it…
The question is why no one is calling for price controls for other products that are produced in a relatively free market. Then ask yourself whats different about the market for insulin that prevents price competition.
Using "fixed" prices to control costs is like using "fixed" thermostat readings to control global warming.
The alternative would be to allow people to break the third party payer system and allow people to buy and import drugs from whomever they want. You can do this now on the grey market, but it would be great if it were legalized. Then you can probably get it for the same price as any other country, probably even lower. If you want, you can have the state cut every insulin user a check for $10 a year or whatever it would cost in a free market